TEACCH is starting to be well known all over the world for the
excellent services provided to autistic people and is often used as a
model as a result. However several misconceptions have been spread
and it seems to be good to give some basic information that will
hopefuly give a faithful description of the TEACCH Program.

First of all, TEACCH is not a single approach and even less a
method. It is a state program that tries to respond to the needs of
autistic people using the best available approaches and methods known
so far for educating them and to provide the maximum level of autonomy
that they can achieve.

If some people have ported successfully out of North Carolina and
even out of the United States some elements of this program, the only
complete implementation of TEACCH as a State Program remains the one of
North Carolina. For the sake of my European friends, I should add that
we were quite lucky in porting some of the TEACCH program in Europe
thanks to Theo Peters, a Belgium professional who received training in
N.C. and helped a lot of European professionals and parents get up to
speed with modern views on autism. The program in Antwerpen is pretty
near to most of the achievements of those in N.C. and constitutes a
closer reference for visits in Europe...

Before I go any further along a description of how TEACCH Program
functions, I will give a few of the considerations that lead us to chose
this program as a model:

As parents quite involved in the autistic society activities, we have
explored hundreds of methods, going from "recipes" to full blown country
wide systems...

TEACCH is one of the two programs for autistic people that met our
quality criteria the other one being the UK National Autistic Society
(NAS) based School system for autistic children which is good but not as
comprehensive as TEACCH.

Here are the considerations that were decisive in our choice of TEACCH
versus other approaches of autism:

Respect for autistic people difference, whatever the degree of
severity of autism

Respect for parents and association of parents in the program
as "Co-Therapists".

Inclusion of parents opinions in decisions regarding younger
children and more severely handicapped autistic adults.

Inclusion of autistic people advice to the maximum extent of
their possibilities of communication.

Warmth of the professionals, mainly due to the next point

In depth knowledge of autism from all points of view: medical,
psychological, educational, social mainstreaming, affective, and yet
these professionals remain very humble.

Long experience with testable long term results (Thirty years).
Education constituting the backbone of the approach.

Continuous evolution of the teaching techniques based upon
University research programs, integrating most recent knowledge
to a long experience.

Comprehensive program from early childhood to adult age, from
diagnosis of very young children to adult evolution assessment,
from low functioning to high functioning.

Transportability of the approach: it could be adapted without
problem to the French environment (or any other country). The
approach is flexible enough to be adaptable.

Last but not least, our overall impression that autistic people
of all ages seemed happy and developing quite well towards a
maximum of autonomy according to their individual capacity. This
was from our own observation and from what parents told us.

So, now to answer the question on what TEACCH is, I hope that every
one will by now realize what stunt this attempt represents... :-)

TEACCH cannot be reduced to a technique, not even to a set of techniques,
not even to a method. It is a complete program of services for autistic
people which makes use of several techniques, of several methods in
various combination depending upon the individual person's needs and
emerging capabilities.

TEACCH (note that this is not a spelling error) stands for Treatment
and Education of Autistic and Communication Handicapped Children, is a
Public Health Program available in North Carolina. The new director is
Dr Gary Mesibov. The head office is located in Chapell Hill, N.C. and
TEACCH has a research section at U.N.C. Hospital.

There are several other offices and facilities all over North Carolina,
with a good geographical coverage.
Services provided go from diagnostic and early counselling for parents and
professionals, to adult community based centers, with all the intermediate
steps in between: psychological assessment, classes, teachers programs,
etc...

The TEACCH Program supervises about 130 Classes for autistic children.
Several centers for adolescents and adults with varying degrees of
mainstreaming according to the capabilities of each person are installed
either in rural areas or in town. Depending upon preferences expressed
by autistic people and their families, country or town setting will be
proposed.

There are few programs in the world that can claim thirty years of
experience with autistic people. TEACCH keeps evolving, they are
continuously refining their approach, challenging old beliefs, adding
new research results. They tend to be cautious there not to introduce
techniques that are not proven on a large scale.

Unlike AIT, VT, Holding and other approaches the TEACCH program doesn't
use a single technique or method. You wont find anybody at TEACCH telling
you that they are going to "cure" autism.

The main goal of TEACCH for autistic children is to help them grow up to
a maximum autonomy at adult age. This includes helping them understand
the world that surround them, acquiring communication skills that will
enable them to relate to other people and giving them as much as possible
the necessary competence to be able to make choices concerning their own
lives.

The major thrust is toward improving communication skills and autonomy to
the maximum of the child potential, using education as a means to achieve
that goal. Educational programs are being revised frequently, according
with the child maturation and progress, since there are no good predictor
of a child evolution and early assessment could prove misleading.

Educational strategies are established individually on the basis of a
detailed assessment
of the autistic person learning abilities, trying to
identify potential for acquisitions rather than deficits.

The assessment called PEP, Psycho Educational Profile tries to identify
areas where the person "passes", areas where the skill isn't there yet,
and areas where the skill is emerging. These domains are then put in an
education program for the person. This assessment is multi dimensional.
This is a must since there is a great variability of skills, even in the
same autistic person, from one domain of competency to the other. (I have
also expended on that subject of assessment on the list earlier)

As opposed to behavior modification, these strategies do not work on the
behavior directly but on underlying conditions that will foster learning
experiences. They also make use of recent cognitive psychology research
results about some differences in particular areas of brain processing
in autistic people versus other people.

When behavior problems occur, they are not treated directly either. The
approach calls for efforts to understand the underlying reasons for this
behavior problem: anxiety, physical pain, difficulty with the task,
unpredictable changes, boredom, etc... The idea is two folds:

A/ By giving the person means to understand better his/her environment,
it (the environment) becomes more predictable and less anxiety generator.
This may require proposing a simpler environment in the early phases of
development and progressively reintroducing complexity as the child
progresses towards more and more autonomy.

B/ By giving means of communication to the person the comprehension
and expression capabilities will enable him/her to understand better
what is being told/asked and to express his/her needs and feelings by
other means than behavior problems.

Direct Behavior Modification isn't completely ruled out. It is reserved
for those behaviors that endanger the person and for which the above
strategy didn't work, at least so far. This is very rare.

I'll reproduce here an answer I made to a parent, who is also a
psychiatrist, following his question:

(Begin quote)

> Is there any risk that such a program could become a
> closed system, like, say, orthodox psychoanalysis--purporting
> to explain everything from one point of view?

Indeed there is always such a risk with any approach. My wife and I
often asked the question to ourselves. We have been fighting very hard
the Psychoanalytic current in France on the basis that it became a closed
system, not capable of following the new results of Neuro Psychology.

We often dread the time when we may be the "old timers" incapable of
adapting to newer research results...

For the moment, though, the people working at TEACCH and the ones
working in programs inspired from TEACCH are continuously trying to merge
new research results into their program and discard no longer valid
approaches.

As an example, recent trends have been in the area of finding ways
to foster spontaneous communication and incidental learning to extend
the reach of structured education which was the main thrust of TEACCH.

There is often a confusion between the goals of a program such as
TEACCH and Pure Behavior Modification Approaches. Behavior modification
approaches are often getting parents approbation as they make sense, at
least at first sight, they offer bounded programs of intervention, and
they work fairly well in the early phases of the program.

Here is a typical comment that we often get about behavior
modification versus other approaches:

> What Behavior Modification does have is step-by-step
> programs that spans several years.
> I haven't seen this from either Sundburg,
> Schoppler, Mesibov, Freeman or others.

Here is an answer that I gave:

I don't know about Sundburg or Freeman, but for Schopler and Mesibov
who run the TEACCH program, if you haven't seen a "step-by-step program that
spans several years" it is because such long term programs are considered
too limiting for the children, considering the continuous evolution of
their capabilities. Educational programs keep being updated.

There is indeed a long term individualized strategy for each child.
That strategy keeps being adjusted throughout the evolution of the child,
according to the progress made in each domain of development. It continues
on at adult age.

In order to have a reliable assessment of these progress, Schopler
Reichler and Lansing devised an evaluation scheme called PEP (Psycho
Educational Profile) and have prolonged this scheme for Adolescents and
Adults: the AAPEP. These schemes give a lot of information to the teachers
and to the parents with regard to what is the appropriate level that can
be successfully taught in each domain of development at the present time
for the child.

Again, I really think that this is where TEACCH and pure Behavior
modification differ. Teaching a specific behavior ceases to be the
main goal of the teachers endeavor. Rather than teaching the behavior
directly, prerequisites skills to that behavior emergence are being
evaluated and if missing they are being taught. The appropriate behavior
comes naturally then.

This is done by placing the child in an environment that fosters such
learning: structured space and time, teaching methods that take into
account the differences of individual learning styles.

Sure, this may take longer than classical behavior modification, but here
the skills are really understood. In a classical behavior modification
program some fairly advanced skills may be learned rather fast, but the
generalization of these skills to other environments will be much more
difficult later on.

This is obviously a valid strategy. It is being used as a last resort
approach, when the above teaching approach isn't producing the desired
effects, at least during the early phases.
But Ignoring the behavior is OK only if we have analyzed its potential
communicative content. Never forget that a behavior problem is very often
caused by a physical pain and since the autistic person doesn't know how
to communicate her pain, she does it through a behavior problem.

The main difference again between TEACCH attitude and pure behavior
modification is that most of the undesirable behavior can be dealt with
without requiring behavior modification, just by providing the autistic
person with the skills that will permit an easier understanding of the
"world" and to make sense of other people behaviors.
For example, in the situation of a behavior problem caused by a lack
of means to express pain, having taught the child how to signal pain
would have avoided the behavior problem all together...

In fact, the modern, non aversive behavior management techniques
apply very good principles.
These techniques are being used when Behavior Problems persist, even
in a favorable learning environment.

There are however some categories of behavior problems that resist all
regular approaches, being the educative one (TEACCH) or the Behavior
Modification one. These are of two sorts:

1/ Hyper sensitivity to certain stimuli, such as described so well by
Temple Grandin. These provoke unbearable pains for those people and
require completely different approaches, mainly centered around avoiding
the painful stimuli situation.

Trying to extinguish such behavior problems via behavior modification,
especially aversive ones, is criminal, and I weight my words. Management
methods for such problems, specifically the second type, are beyond the
means that can be expected from regular intervention. They require the
help of specialists that will try to solve the problem, but always with
great difficulty and not always with great success. (very sad)

The situations that I addressed in the first part are obviously less
tragic. For them Education remains the best solution, in combination
with non-aversive behavior modification to cope with behavior problems
that persist.

Very often the name of Lovaas comes as a behavior modification
expert. He certainly qualifies for that. In the past however he did
push the behavior modification techniques to extremes, including
fairly painful treaments of autistic people as a way to teach them
what behavior were undesirable. These are often refered as "Aversive
Behavior Modification".

Recently, there have been reports telling that Lovaas programs have
changed for the better, and I will be the first to say that I am happy of
that change. There are however still some programs that claim to be based
upon Lovaas theories where the "strong aversive" methods are instituted
as a valid approach, not only of severe behavior problems but as teaching
methods in general.

Don't misunderstand me here, I do not approve of "strong aversive" in any
case, not even for severe behavior problems. In fact, I am glad to see
that in the "Lovaas new version" even problem behaviors <>

This is obviously better than before and I am sure that it is effective,
at least with some autistic children. I consider, however, that it is
possible to go beyond behavior modification, be it for behavior problems
or for other general learning purpose.

Behavior modification is inspired by "Behaviorist psychology" which was
indeed a progress compared with the earlier theories. One of the basic
element of that theory was that it was enough to look at the visible
behavior as a response to a stimuli. What ever was happening in the brain
was considered happening in the "black box" and as being beyond real
investigation. The psychologist observes that a specific stimuli provokes
a specific response, that's all.

Operand conditioning, which is the root of behavior modification, hence
does not take in account other psychological phenomenons that are taking
place "IN the black box".

Recent progress in psychology and in neuro psychology, (In fact starting in
the late sixties, early seventies) have started to unveil some of the mystery
of the "black box" which are key to our understanding of autism, even
partly, but more importantly, to propose more adapted treatments of autism
than the pure behavior modification.

This is not to say that behavior modification techniques have been thrown
out completely, but that they are now integrated in a more comprehensive
education program.

So I believe statements like << every parent who has tried Lovaas has
seen significant improvement in the behavior, language, socialization,
problem solving and motor skills of their child.>>

It has even been shown that behavior modification "Lovaas style"
tends to have faster short term effects that other education methods
but that this is only true in the short term.

I also believe that equivalent visible progress would have been seen in a
program like the TEACCH program in North Carolina, albeit in a longer
period, but beyond that, long term effects such as generalization of
learning capability to adapt to new situations have a better prospect in
a program like TEACCH, or also in the programs proposed in the English
schools managed by the N.A.S. (UK National Autistic Society).